From Broken Heart to Brain: A Case of Stroke Complicating Takotsubo Cardiomyopathy

Introduction Takotsubo cardiomyopathy (TCM) is a non-ischemic syndrome characterized by transient left ventricular dysfunction, triggered by physical or emotional stress. [1] Due to its similar clinical manifestation it can be indistinguishable from acute coronary syndrome. Although the prognosis for TCM is generally favourable, some patients may face an increased risk of ischemic stroke. [2] We present a case of a patient who was diagnosed with TCM and experienced an acute ischemic stroke during the period of in-patient treatment. Case Presentation A 76-year-old female was admitted to Lithuanian university of health sciences hospital Kaunas clinics in 2024 due to suspected acute myocardial infarction, presenting with chest pain and fatigue. Coronary artery angiography revealed no coronary artery stenoses. Ventriculography revealed left ventricle (LV) dilation and systolic function impairment, typical to TCM, further proved by transthoracic echocardiography. Cardiac magnetic resonance imaging was performed to rule out an acute ischemic event. The results confirmed TCM, also revealing the presence of a LV thrombus. The thrombus subsequently led to the development of an ischemic stroke, which was further evaluated by performing a computed tomography scan. Over time, the patient's cardiac function gradually improved, as she was treated appropriately for TCM, heart failure and ischemic stroke. To treat the neurological condition and remaining neurological deficit, the patient underwent a neurorehabilitation program. Discussion The exact mechanism of ischemic stroke development in presence of TCM remains uncertain. [3] TCM can be both a primary source of an embolism and a secondary outcome of a preceding stroke. [4] The potential for thrombus formation within the akinetic LV apex suggests a direct embolic pathway, yet other mechanisms may also contribute. [5] Recognizing these peculiarities is essential for improving risk stratification and guiding therapeutic strategies in affected patient populations. Conclusions TCM can often be misdiagnosed as an acute ischemic syndrome due too its similar clinical presentation. Its association with LV thrombus formation, leading to stroke complications, is often unrecognized. This highlights the importance of careful differential diagnosis and close monitoring of patients with TCM.